How employers are rethinking the pharmacy benefit to address specialty drugs

Drug prices
A new Willis Towers Watson analysis examines how employers are tackling specialty drug costs. (Getty/Charles Wollertz)

As growing numbers of specialty drugs come through the development pipeline, employers are finding new strategies to manage the associated costs, a new report from Willis Towers Watson shows.

Katie Asch, senior director and U.S. consulting pharmacy practice lead at WTW, told Fierce Healthcare that two-thirds of new drug approvals are for specialty drug products. In addition, these products are gaining approval for additional indications, Asch said.

For example, Sanofi's Dupixent was launched as a drug to treat eczema but has since been approved for asthma, she said.

"We’re also seeing an expansion of the types of conditions and indications that existing specialty drugs can be used for," she said.

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The WTW analysis groups potential solutions in financial and clinical responses, with financial options focusing on costs directly and clinical solutions focusing on utilization. For instance, utilization management tools like prior authorization can ensure patients are taking drugs appropriately, while copay assistance programs can manage individual costs.

In addition, according to the report, employers are finding ways to deploy multiple solutions in tandem. The insurer may offer a stop-loss program that can work well in tandem with advanced strategies for chronic care management, for example.

In addition, Asch said, employers are looking outside of the pharmacy benefit itself to manage costs and examining ways to better manage the costs of drugs administered under the medical benefit, which are typically infusion products.

"We're seeing plans focus a bit more attention there if they have already pulled all the levers," she said.

The report also highlights some drug products that are expected to get the Food and Drug Administration's OK in the coming months. Ponesimod, a therapy for multiple sclerosis, is expected to be approved around March 18 and would cost between $60,000 and $80,000 per year.

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Several multimillion-dollar therapies are set for approval this year, too, according to the report. Eladocagene exuparvovec, a treatment for aromatic I-amino decarboxylase deficiency (AADC), is aiming for 2021 approval and costs $4 million for a one-time infusion. AADC is a rare condition with just 100 patients identified in the U.S., however.

For therapies targeting conditions that are less rare, Lenti-D (elivaldogene  autotemcel) is aiming for a 2022 approval and treats adrenoleukodystrophy, which affects 1 in 15,000 live births. The drug is likely to secure a one-time infusion cost of at least $2 million, according to the report.

However, even as employers consider solutions to tackle these costly therapies, Asch said it's critical for them to keep the costs of more common drugs in their sights, too. 

"The vast majority of employers are definitely interesting and focused on ways they can help to bend the curve," she said. "They are looking for creative ways kind of across the spectrum to address the cost."